Fukami Yuki, Koike Haruki, Iijima Masahiro, Hagita Junichirou, Niwa Hisayoshi, Nishi Ryoji, Kawagashira Yuichi, Katsuno Masahisa
Department of Neurology, Nagoya University Graduate School of Medicine, Japan.
Center for Advanced Medicine and Clinical Research, Department of Advanced Medicine, Nagoya University Hospital, Japan.
Intern Med. 2020 Feb 1;59(3):435-438. doi: 10.2169/internalmedicine.3228-19. Epub 2019 Oct 7.
We herein report the case of a 67-year-old man who presented with the acute onset of limb weakness. Brain magnetic resonance imaging revealed multiple abnormal-signal-intensity lesions. Steroids were administered, and the patient initially responded. Nerve conduction testing findings were consistent with demyelinating polyneuropathy. A sural nerve biopsy specimen revealed fascicles with extensive onion-bulb formation. Although skin and sural nerve biopsies showed no atypical cellular infiltration, the histopathological diagnosis of intravascular large B-cell lymphoma was obtained by a brain biopsy. The neuropathy in this patient may be attributed to a demyelinating process independent of ischemic damage by lymphoma.
我们在此报告一例67岁男性患者，其出现急性肢体无力。脑部磁共振成像显示多个异常信号强度病灶。给予了类固醇治疗，患者最初有反应。神经传导测试结果与脱髓鞘性多发性神经病一致。腓肠神经活检标本显示束状结构有广泛的洋葱球样形成。尽管皮肤和腓肠神经活检未显示非典型细胞浸润，但通过脑部活检获得了血管内大B细胞淋巴瘤的组织病理学诊断。该患者的神经病变可能归因于与淋巴瘤缺血性损伤无关的脱髓鞘过程。
